Knowing when to refer a person with osteoarthritis for consideration for a joint replacement is a challenge for healthcare professionals working in primary care. There are few contraindications to surgery now that it can be performed without a general anaesthetic. Joint replacement can have significant benefits to function, pain and quality of life. It is unclear which prognostic factors demonstrate that surgery would be beneficial, and surgeons do not have the resource to evaluate everyone. Decision making for referral does not usually occur on the basis of imaging, rather on clinical assessment. Musculoskeletal interface services often sit between primary care and orthopaedic services to support appropriate use of noninvasive approaches before referral onto surgery.